Provider Demographics
NPI:1285225995
Name:SHAABAN, FADY (DDS)
Entity Type:Individual
Prefix:
First Name:FADY
Middle Name:
Last Name:SHAABAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 BUNTING CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3691
Mailing Address - Country:US
Mailing Address - Phone:224-801-9108
Mailing Address - Fax:
Practice Address - Street 1:287 BUNTING CT
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3691
Practice Address - Country:US
Practice Address - Phone:224-801-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist